Validation of the Blatchford Bleeding Score in Cancer Patients with Upper Gastrointestinal Bleeding

PURPOSE: The Glasgow Blatchford Score (GBS) and the Rockall score are validated risk tools for predicting adverse outcomes in patients with upper gastrointestinal bleeding (UGIB). In this study, we attempted to validate these risk assessment tools in patients with active cancer who visited an emergency department (ED) with UGIB. METHODS: We retrospectively reviewed electronic medical records of patients with active cancer presented to Asan Medical Center ED from January 2009 to December 2011. The primary outcomes required therapeutic interventions (transfusion, endoscopic/surgical/radiologic interventions), and there was a recurrence of bleeding or mortality within 30 days. RESULTS: Of the 225 patients, 197(87.6%) needed interventions. The area under the receiver-operator curves showed that the GBS [0.86; 95% Confidence Interval (CI), 0.77-0.95] surpassed the clinical Rockall (0.67; 95% CI, 0.55-0.79) and full Rockall scores (0.72; 95% CI, 0.61-0.83) in predicting clinical interventions. Regarding a score of 2 or less as negative, the GBS showed a sensitivity of 0.99 and a specificity of 0.54. When patients were divided according to their source of bleeding, the sensitivity and specificity did not change. CONCLUSION: The GBS outperformed clinical and full Rockall scores in predicting the intervention in patients with active cancer. The source of bleeding was not an important factor in the score's performance. The GBS also showed very good sensitivity; however, its specificity is suboptimal and limits its role as a sole indicator for decisions in cancer patients with UGIB.

Serum Procalcitonin and C-reactive Protein Level as an Early Diagnostic Marker of Bacterial Meningitis in the Emergency Department

PURPOSE: Immediate identification of bacterial meningitis (BM) is essential in the emergency department. However, diagnosis of BM from analysis of cerebrospinal fluid has low sensitivity. The goal of this study was to determine the ability of serum procalcitonin (PCT) and C-reactive protein (CRP) for differentiation between BM and non-BM in adult patients. METHODS: This retrospective cohort study, which was conducted from Jan 1 2008 to Sep 30 2011, included patients with a diagnosis of meningitis based on compatible clinical features and cerebrospinal fluid (CSF) culture findings with a CSF leukocyte count > 5 /microL. Measurement of Serum PCT and CRP level was performed on initial admission to the emergency department. Patients were divided into two groups, according to the type of meningitis: BM or non-BM. Clinical features, laboratory results, including CSF results, serum PCT, and CRP levels were assessed. RESULTS: A total of 63 patients (age, 49+/-19) with confirmed meningitis were admitted: 43 patients with non-BM and 20 patients with BM. Significantly higher PCT and CRP levels, CSF white blood cell and neutrophil count, CSF glucose, and protein levels were observed in the BM group. The most highly discriminative parameters for differential diagnosis of BM proved to be serum PCT, with a sensitivity of 90%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 96% at a diagnostic cut-off level of 1.0 ng/mL (area under the curve 0.98; 95% confidence interval 0.00-1.00) and CRP, with a sensitivity of 85%, a specificity of 88%, a positive predictive value of 77%, a negative predictive value of 93% at a diagnostic cut-off level of 6.0 mg/dL (area under the curve 0.91; 95% confidence interval 0.76-0.97). CONCLUSION: Serum PCT and CRP levels appear to be the most highly discriminative parameters for differential diagnosis of BM and non-BM.

The Adequate Amount Irrigation After Cemented Total Knee Arthroplasty / 대한정형외과연구학회지

PURPOSE: We studied the adequate amount of pulse lavage irrigation for removal of polymethyl methacrylate (PMMA) and bone particles after cemented total knee arthroplasty. MATERIALS AND METHODS: A prospective study of 8 patients who received cemented total knee arthroplasty between March 2011 and November 2011, was done. The mean age of patients was 74.0 (range 65~84). After component implantation, the knees were lavaged with 10L of normal saline using pulsatile lavage; all fluid was collected in 1 liter using standard wall suction canisters. PMMA and bone particles within the irrigation fluids were quantitated by weight. RESULTS: The average of 413 mg/L (range, 71~999 mg/L) of particle debris was removed after cemented total knee arthroplasty with 1L of irrigation. Average of 230 mg/L (range, 51~432 mg/L), 112 mg/L (range, 32~185 mg/L), 48 mg/L (range, 21~125 mg/L), 47 mg/L (range, 10~120 mg/L), 45 mg/L (range, 5~140 mg/L), 49 mg/L (range, 0~110 mg/L), 46 mg/L (range, 0~107 mg/L), 50 mg/L (range, 5~85 mg/L), 41 mg/L (range, 3~68 mg/L) of debris was removed after the second, third ,fourth, fifth, sixth, seventh, eighth, ninth and tenth liter of pulse lavage irrigation respectively. Using analysis of variance testing, there was a statistically significant difference between the debris removed with 1L and until 4L irrigation (p=0.03). CONCLUSION: The bone debris and PMMA decreased as the amount of irrigation increased, especially most of remnants within more than 5L solution for irrigation were bone particles. 4L of irrigation through pulse lavage is appropriate for removing PMMA and bone particles after cemented total knee arthroplasty because a supplementary irrigation can cause a secondary bone loss.

The Adequate Amount Irrigation After Cemented Total Knee Arthroplasty / 대한정형외과연구학회지

PURPOSE: We studied the adequate amount of pulse lavage irrigation for removal of polymethyl methacrylate (PMMA) and bone particles after cemented total knee arthroplasty. MATERIALS AND METHODS: A prospective study of 8 patients who received cemented total knee arthroplasty between March 2011 and November 2011, was done. The mean age of patients was 74.0 (range 65~84). After component implantation, the knees were lavaged with 10L of normal saline using pulsatile lavage; all fluid was collected in 1 liter using standard wall suction canisters. PMMA and bone particles within the irrigation fluids were quantitated by weight. RESULTS: The average of 413 mg/L (range, 71~999 mg/L) of particle debris was removed after cemented total knee arthroplasty with 1L of irrigation. Average of 230 mg/L (range, 51~432 mg/L), 112 mg/L (range, 32~185 mg/L), 48 mg/L (range, 21~125 mg/L), 47 mg/L (range, 10~120 mg/L), 45 mg/L (range, 5~140 mg/L), 49 mg/L (range, 0~110 mg/L), 46 mg/L (range, 0~107 mg/L), 50 mg/L (range, 5~85 mg/L), 41 mg/L (range, 3~68 mg/L) of debris was removed after the second, third ,fourth, fifth, sixth, seventh, eighth, ninth and tenth liter of pulse lavage irrigation respectively. Using analysis of variance testing, there was a statistically significant difference between the debris removed with 1L and until 4L irrigation (p=0.03). CONCLUSION: The bone debris and PMMA decreased as the amount of irrigation increased, especially most of remnants within more than 5L solution for irrigation were bone particles. 4L of irrigation through pulse lavage is appropriate for removing PMMA and bone particles after cemented total knee arthroplasty because a supplementary irrigation can cause a secondary bone loss.

Bilateral Total Knee Arthroplasty using the Fixed Bearing Platform and the Rotating Platform in the Same Patient

PURPOSE: We wanted to evaluate the clinical and radiological results after total knee arthoplasty using the Press Fit Condylar (PFC) Sigma fixed bearing platform knee and the rotating platform knee in the same patient. MATERIALS AND METHODS: We enrolled 44 patients who had undergone bilateral total knee arthroplasties due to osteoarthritis of both knees from November 2001 to December 2004, using the fixed bearing platform and the rotating platform, respectively. The mean age of the study group was 71.5 years (range: 65~85 years). The mean follow up period was 74.3 months (range: 62~86 months). The clinical results were evaluated according to the knee score, the functional score, the presence of flexion contracture, the range of motion and the complications, and the visual analog scale system was used for the patients' satisfaction. The radiological results using the American Knee Society criteria and the tibiofemoral angle were also evaluated. RESULTS: The average knee score improved from 36.5 to 87.3 in the fixed bearing group and from 38.8 to 87.9 in the rotating platform group, respectively. The average functional score improved from 28.4 to 83.5 in the fixed bearing group and from 32.6 to 85.8 in the rotating platform group, respectively. The average range of knee motion improved from 85.5degrees to 115.5degrees in the fixed bearing group and from 86.6degrees to 116.8degrees in the rotating platform group. The average tibiofemoral angle improved from varus 8.2degrees to valgus 5.5degrees in the fixed bearing group and from varus 7.1degrees to valgus 5.3degrees in the rotating platform group. We did not observe any clinically significant osteolysis or wear. However, there were 3 cases of instability out of the 13 cases in rotating platform group, and this was accompanied by varus deformities of over 15 degree and 6 cases of friction sound during walking. CONCLUSION: We could find no clinical and radiological differences between the fixed bearing platform and the rotating platform in this study. However, we should regard the fixed bearing prosthesis as a good option for the patients with severe varus deformities, with considering performing bulky soft tissue release for obtaining a balanced gap, for preventing spin-out and to correct deformity.

Assessment of the Clinical Features of Bilateral Sequential Hip Fractures in the Elderly / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the clinical features after treating of bilateral sequential hip fractures in the elderly. MATERIALS AND METHODS: We reviewed the clinical records of 21 patients who were older than 75 years and who underwent bilateral bipolar hemiarthroplasty for sequential hip fractures between March 1999 and November 2005. The minimum follow up period was 2 years. We analyzed the results by conducting radiological and clinical evaluations such as assessing the patient's walking ability, the activities of daily living, the mechanism of fracture and the associated medical conditions and arthritis. RESULTS: Walking ability was recovered by 18 cases of primary fracture and by 14 cases of sequential fracture. Return to the activities of daily living was achieved by 14 cases of primary fracture and by 14 cases of sequential fracture. The fracture mechanism was a fall/slip in 20 cases and a fall from a height in 1 case. The associated arthritis was in the spine in 14 cases, the knee in 11 cases, the shoulder in 8 cases and Hallux valgus in 5 cases, and the associated medical conditions were mainly urge incontinence in 17 cases and cardiovascular disease in 16 cases. The other previous fractures were spine compression fracture in 11 cases, ankle fracture in 6 cases, distal radius fracture in 5 cases and pelvic ramus fracture in 2 cases. CONCLUSION: Preventing recurrent falls plays a role in preventing bilateral sequential hip fractures. We think that the treatment of curable associated medical conditions and arthritis is necessary to prevent recurrent falls.

Operative Treatment for Ulnar Styloid Process Fractures with Unstable Intraarticular Distal Radius Fractures

PURPOSE: To evaluate the radiological and clinical outcomes of the operative treatment for the unstable distal radius fractures with displaced ulnar styloid process fractures. MATERIALS AND METHODS: From 2002 to 2005, 17 patients with unstable distal radius fractures with displaced ulnar styloid process fractures were treated operatively, using external fixation or internal fixation for distal radius and open reduction with tension band wiring for ulnar styloid process fractures. We evaluated postoperative outcomes with Mayo wrist score, range of motion, ulnar side wrist pain, wrist stress test, grip strength as well as radiological evaluation. RESULTS: All ulnar styloid process fractures were completely united, and according to Mayo wrist score, 7 cases(41%) were excellent, 8 cases(47%) were good. 14 cases(82%) had no ulnar wrist pain and 15 cases(88%) had grip strength more than 50% when compared with the normal side. Posterior instability of ulnar head occurred at 1 case. CONCLUSION: We got acceptable clinical and radiological results of operative treatment of ulnar styloid process fractures and concluded that ulnar styloid process fractures combined with distal radius fractures should be carefully evaluated and treated operatively according to their fracture types.

Risk Factors of Postoperative Delirium in Elderly Patients with Hip Fractures

PURPOSE: To find out the relationship between various risk factors and post-operative delirium in elderly patients with hip fractures. MATERIALS AND METHODS: Out of 135 patients older than 65 years old who underwent the surgery for hip fracture in our department, between the periods of March 2003 to March 2005, 14 patients (10.4%) developed post-operative delirium and 121 patients (89.6%) did not. We studied risk factors of post-operative delirium in two groups. RESULTS: In chi-square test between delirium group and non-delirium group, the patients were more likely to develop post-operative delirium if they had previous episodes of delirium, abnormal cognitive function, low walking ability before admission, high dependency on ADL (Activities of Daily Living), other medical accompanying diseases, history of dementia, post-operative hypoxia, post-operative electrolyte imbalance, low post-operative hemoglobin and hematocrit, low post-operative albumin and were older than 75 years old (p<0.05). Sex, type of fracture, anesthesia and the time between admission and operation did not show much difference between the two groups. CONCLUSION: The risk factors of postoperative delirium in elderly patients with hip fracture have a tendency to be multifactorial. Therefore, we conclude that being prepared by thorough understanding of the risk factors and their relationships will help prevent post-operative delirium and result in good postoperative prognosis.

Bipolar Hemiarthroplasty for Femoral Neck Fractures in the Elderly

PURPOSE: To evaluate outcomes after treatment of femoral neck fractures in patients 75 years of age or older. MATERIALS AND METHODS: We reviewed the records of 186 patients 75 years of age or older who underwent bipolar hemiarthroplasty between March 1995 and March 2005 and who were followed for more than two years after surgery. The mean patient age was 84.3 years (range 75~99 years). Forty-eight patients were men, and 138 patients were women. The mean follow-up period was 68.4 months (range 24~113 months). We evaluated the results by analyzing modified Harris hip score, walking ability, activities of daily living, complications, osteoporosis, and radiologic findings. RESULTS: The mean Harris hip score was 89.2 (range 74~95). Walking ability was recovered in 87.6% of cases (163 cases), and activities of daily living were achieved in 85.4% of cases (159 cases). There were 3 cases of acetabular erosion or proximal migration and 3 cases of aseptic loosening in a cemented stem. Thigh pain occurred in 8 cemented stems and in 4 cementless stems. CONCLUSION: We believe bipolar hemiarthroplasty is a useful treatment in elderly patients with femoral neck fractures and severe osteoporosis, especially in view of the stable and rigid fixation of the femoral stem, early ambulation, and the low rate of complications and death, even if the operation is technically very difficult.

Polyethylene Wear between Farming and Non-Farming Patients after Total Knee Arthroplasty

PURPOSE: We evaluated the polyethylene wear rate between patients from farming and non-farming communities to determine whether active life styles, knee scores, and occupations could affect outcomes. MATERIALS AND METHODS: 201 knee replacements were performed in 105 patients who were an average of 68.7 years old. 30 non-farming patients(59 cases) and 75 farming patients(142 cases) who had operation between 1989 and 1996 were reviewed retrospectively. Mean follow-up period was 12.1 years(range 10~16 years). The difference of clinical, radiographic, and functional results of total knee replacement were assessed by Knee Society scores and activity levels. RESULTS: The non-farming group had lesser activity levels(non-farming group 82.5, farming group 89.7), higher knee scores(non-farming group 88.4, farming group 81.1) and functional scores(non-farming group 87.9, farming group 80.4) than the farming group(p<0.05). Farming patients showed 33 cases(23%) of polyethylene wear and non-farming patients showed 7 cases(12%) which is statistically significant(p<0.001). CONCLUSION: Primary osteoarthritic patients from farming communities had higher activity levels and polyethylene wear rate with lower Knee Society scores which were expected to participate in more activities involving impact on knee joint. We assume that the increase rate of complication is due to the overuse of the prosthesis. Therefore, working condition and life style modification will be needed.

Revision Total Knee Arthroplasty using Femoral Head Allograft

PURPOSE: We evaluate the results of allograft using femoral head in revision total knee arthroplasty with severe bone defects. MATERIALS AND METHODS: Between March 2000 and February 2005, the clinical records on 22 cases that had undergone the revision total knee arthroplasty using femoral head allograft were reviewed. Mean follow up period was 48(24~80) months. Allografts were used at proximal tibia in 12 cases, distal femur in 7 cases, both in 3 cases. We used posterior cruciate ligamental substituting component with extension rod in all cases. The clinical results were assessed with the knee score and functional score of Knee Society Knee Score(KSS), complication, union of allograft and so forth. We evaluated complications and union of the allograft. RESULTS: Mean degrees of preoperative and postoperative range of motion were 94+/-14 and 105+/-12 respectively. Postoperative mean knee score of KSS was increased from 45+/-10 to 79+/-8, and functional score was increased from 42+/-13 to 83+/-9. Union of allograft were observed in all cases. There were no infection, absorption and fracture of allograft. CONCLUSION: We consider allograft using femoral head in revision total knee arthroplasty with severe bone defects is one of the useful method.

Trochanteric Management for Unstable Intertrochanteric Femoral Fracture in the Elderly Patients

PURPOSE: To evaluate the results after fixation with figure of eight and cerclage wiring for comminuted trochanteric fracture. Because comminution of the femoral trochanteric fracture in elderly patients is severer in the operating field than x-ray findings, so the fixation is more difficult. MATERIALS AND METHODS: Between March 1998 and March 2004, the clinical records on twenty-eight patients more than 70 years old who underwent the bipolar hemiarthroplaty using calcar replacement type of femoral stem and followed more than 24 months were reviewed. Figure of eight and cerclage wiring was used for the comminuted trochanteric fracture of the femoral intertrochanteric fracture. The mean age was 80.4 (70~103) years. 19 cases were female, 9 cases were male. Mean follow-up period was 58 (24~92) months. We evaluated the results by modified Harris hip score, walking ability, activity of daily living, radiologic findings and union of the fracture. RESULTS: The mean duration of bony union was 12 weeks. The mean postoperative modified Harris hip score was 82.3. Preoperative walking ability was recovered in 23 cases (82%). Also basic activity of daily living was recovered in 22 cases (79%). Nonunion of trochanter was found in only one case by radiologic evaluation but clinical correlation was not significant. CONCLUSION: We consider fixation with figure of eight and cerclage wiring for unstable intertrochanteric fracture of femur in the elderly patient is more appropriate in terms of convenience of fixation, duration of union, early ambulation and cost effectiveness.

Total Knee Arthroplasty for Posttraumatic Arthritis : Comparison of the Results with Primary Degenerative Osteoarthritic Patients

PURPOSE: To compare the results of a total knee arthroplasty (TKA) between the degenerative osteoarthritic patients and the posttraumatic arthritic patients. MATERIALS AND METHODS: 38 cases with posttraumatic arthritis (group A) and 40 cases with degnerative osteoarthritis (group B) had a total knee arthroplasty between April 1995 and May 2002. The knee score, functional score, activity level and radiologic analyses were performed. RESULTS: There were no significant difference in the knee score, functional score, activity level and radiological findings between the two groups. The range of motion arcs were reduced in the posttraumatic arthritic patients. There is a higher complication rate in the post-traumatic arthritic patients (36%) when compared with the degenerative osteoarthritic patients (15%) after TKA . CONCLUSION: In group A showed a higher complication rate and reduced range of motion arcs. However, in terms of our results, we considered that a total knee arthroplasty is an useful treatment for the posttraumatic arthritis in spite of the technical difficulties.

Postoperative Mortality Rate of Hip Fracture in Elderly Patients

PURPOSE: To evaluate the rate of mortality for the elderly patients after treatment of hip fractures and analyze the associated risk factors which might affect their mortality rate. MATERIALS AND METHODS: About the clinical records on 305 patients who had undergone the treatment in hip fractures, we evaluated the mortality rate of the total number of 248 patients whose age between 70 and 103 who were followed more than 12 months of period between March 1994 and March 2003. The mean age was 81.3 years. The composition of each female and male were 176 and 72 cases respectively. 99 cases were femoral neck fractures, and 149 cases were femoral intertrochanteric fractures. The operation included bipolar hemiarthroplasty and internal fixation using multiple cannulated screws, compression hip screws and Ender nails. We compared and analyzed the relating factors for the mortality rate. RESULTS: The mean postoperative mortality rate was 14.1% (35 cases). The highest mortality rate showed for the postoperative 3 months which was 57.1% (20 cases), between 4 and 6 months was 25.7% (9 cases), and 17.1% (6 cases) were presented for 7 and 12 months. The postoperative mortality rate within 1 year was affected by underlying diseases, ASA (American society of Anesthesiologists) and cemented bipolar hemiarthroplasty. but, there were no significant difference of the other factors such as the age, gender, osteoporosis and delayed operation. CONCLUSION: The variable factors which affect the mortality rate of the hip fractures in the elderly patients whose age over 70 were mostly determined by underlying diseases, ASA grade, and cemented bipolar hemiarthroplasty. Further study should be necessary for the factors influencing on the mortality rate.

Treatment of the Hip Fracture in Elderly Patients with Cerebrovascular Accident (CVA)

PURPOSE: To evaluate the results of the treatment of the hip fractures in elderly hemiplegic CVA patients with disuse osteoporosis. Hemiplegic CVA patients have much difficulties in rehabilitation such as walking, daily activity of living and so forth. MATERIALS AND METHODS: The clinical records on thirty-four CVA patients who had undergone the treatment in hip fracture and followed more than 12 months of period between March 1998 and March 2004 were retrospectively reviewed. The treatment methods were 22 cases of bipolar hemiarthroplasty, 6 cases of compression hip screw, 3 cases of ender nail, 3 cases of multiple cannulated screw. We compared the groups underwent bipolar hemiarthroplasty (Group I), internal fixation (Group II), fracture in ipsilateral (Group A), fracture in contralateral (Group B). We evaluated the results by modified Harris hip score, walker ambulation time, walking ability and activity of daily living. RESULTS: The mean postoperative modified Harris hip score was decreased in Group I (11.7 points), Group II (9.6 points), Group A (10.0 points), Group B (12.3 points). Recovery of preoperative walking ability was achieved in total 21 cases (62%) that 7 cases (58%) were observed in Group I, 14 cases (64%) in Group II, 18 cases (67%) in Group A and 3 cases (43%) in Group B. Basic activity of daily living was possible in 18 cases (53%). CONCLUSION: Hemiplegic CVA patients with hip fracture have much difficulties in rehabilitation. However, with appropriate treatment and confident positive attitude for rehabilitations of the patients, doctors and family members, we can expect more reliable results close to the pre-injury status in terms of walking ability and activity of daily living.

Condylar Lift Off in Fixed and Mobile Bearing Total Knee Arthroplasty

PURPOSE: To compare the performance of a total knee arthroplasty with either a PFC Sigma fixed bearing or a rotating platform in the same patient. MATERIALS AND METHODS: 48 cases (24 patients) that received a PFC Sigma fixed bearing and a rotating platform in both knees, one in each knee. The knee score, functional score, activity level, radiologic analyses through fluoroscope , varus/valgus stress, and subjective satisfaction evaluation were performed at the last follow up in the same patient. RESULTS: There were no significant differences in the knee score, functional score, activity level, radiological findings through fluoroscope, and subjective satisfaction. In the varus/valgus stress views, 3 cases of lateral femoral condylar lift-off were observed in the fixed bearing type and 6 cases of lateral femoral condylar lift-off were observed in the rotating platform type. CONCLUSION: In cases of total knee arthroplasty with PFC Sigma fixed bearing and with rotating platform performed in the same patient, there were no significant differences in the clinical, radiological and subjective satisfaction. However, it is considered that the fixed bearing is more stable in terms of medial and lateral femoral condylar lift-off with varus and valgus stress than rotating platform. Therefore long term follow-up would be necessary.

Moderate to Severe Varus Deformity in Total Knee Arthroplasty: PFC Sigma Fixed Bearing Versus Rotating Platform / 대한정형외과학회잡지

PURPOSE: To compare the performance of a fixed bearing with a PFC Sigma with that of a rotating platform in a total knee arthroplasty performed on patients with a moderate to severe varus deformity. MATERIALS AND METHODS: Among the patients who had received a total knee arthroplasty with either a PFC sigma fixed bearing or a rotating platform between October 1998 to June 2002, 77 cases (53 patients) with a > 15degrees varus deformity were examined. The surgery time and the clinical ratings and the radiographic images for each patient were investigated. RESULTS: There were no significant differences in the knee score, functional score, activity level, or radiological findings. There were seven cases where friction sounds were produced from the insertions in the rotating platform whilst walking and there were three cases of lateral instability. CONCLUSION: The PFC sigma fixed bearing was more effective for stabilizing the knees with a moderate to severe varus deformity because the rotating platform had a friction sound from the insertions while walking and lateral instability.

The Short-term Results of PFC Sigma Rotating-Platform in Total Knee Arthroplasty

PURPOSE: To evaluate the short-term results of PFC Sigma Rotating-Platform in total knee arthroplasty. MATERIALS AND METHODS: From November 2001 to April 2002, 41 knees in 25 patients who had been followed up over 2 year after TKA with PFC Sigma Rotating-Platform were evaluated retrospectively. RESULTS: The average range of motion increased from 96.9 degree preoperatively to 122.3 degree at the last follow-up. The average preoperative knee score (44.2) and functional score (51.3) improved to 90.8 and 92.1 respectively. The average score of activity level by authors 'improved from 42 preoperatively to 87 post-operatively. The radiolucent lines around prosthesis were found in 12% at femur and in 24% at tibia. But, none showed any clinical significance. Complications were superficial infections in 3 knees. CONCLUSION: The short-term results of PFC Sigma Rotating-Platform TKA were satisfactory. Therefore, long term follow-up evaluation is necessary.

Treatment of Intertrochanteric Fracture of the Femur with Ender Nail in the Elderly Patients with High Risk of Anesthesia

PURPOSE: To evaluate the usefulness of IM Ender nail in treating femoral intertrochanteric fractures with high risks including cardiovascular disease, pulmonary disease, liver cirrhosis, cerebrovascular disease, metastatic cancer, and skin problem at hip joint region. MATERIALS AND METHODS: Thirty-five patients of pre-existing diseases and femoral intertrochanteric fractures treated with Ender nailing, January 1990 to November 1997. Under the c-arm guided, closed reduction and internal fixation were performed using Ender nails, We analized operation time, blood loss, bone union, ambulation time and complications RESULTS: Mean operation time was 55 minutes, mean blood loss was 120 ml, mean radiological bone union was 12 weeks and average of partial weight bearing was 6.9 days. Postoperative complications were gastrointestinal discomfort in 3 cases, superficial wound infection in 1 case, knee pain in 7 cases, inguinal pains in 5 cases, distal migration of nails in 3 cases, varus deformity in 2 cases, proximal migration of nail with nonunion in 1 case. CONCLUSION: The intramedullary ender nail is useful method in treating femoral intertrochanteric fractures in high risk patients of anesthesia and blood loss or skin problem at hip joint region.